More than 30 million older Americans are enrolled in Medicare Advantage plans, wooed by lower premiums and more benefits than traditional Medicare offers.
Since Medicare is funded by the federal government (not by FICA taxes), how is Medicare Advantage able to “woo” people with lower premiums and more benefits? What is their secret to saving?
But a bipartisan group of lawmakers is increasingly concerned that insurance companies are preying on seniors and, in some cases, denying care that would otherwise be approved by traditional Medicare.
Is this a surprise? Preying on seniors and denying care is the whole point of Medicare Advantage. The government created the program to reward the rich.
Any thinking person could predict that a private, for-profit program, competing with a government not-for-profit program, would have to deny services and fool customers. How else can they make a profit while taking business from the government program?
“It was stunning how many times senators on both sides of the aisle kept linking constituent problems with denying authorizations for care,” Sen. Ron Wyden (D-Ore.) said in an interview, referring to a bevy of complaints from colleagues during a recent Senate Finance Committee hearing.
Businesses are strongly motivated to deny authorizations for the most expensive procedures, the exact procedures for which people most need insurance. Prior authorization is a notorious scam.
Congress has already gone after insurers for their celebrity-filled ads and misleading directories. But its scrutiny of these care denials, expected to continue into next year, could have a far greater impact and reshape the rules for one of the most profitable parts of the insurance industry.
The private health insurance industry cannot survive without prior authorization or some other process that skims away their highest costs.
“CMS is very attuned to what is going on on the Hill,” Sean Creighton, managing director of policy for consulting firm Avalere Health, said of the Centers for Medicare and Medicaid Services. He added that next year will likely bring “more scrutiny by the Hill and CMS on this, and there will be more reporting requirements for the plans and actions the plans are required to take to lessen the burden on providers and patients.”
Yes, “more scrutiny and more reporting requirements” — anything to avoid doing what really should be done: Eliminate FICA and offer federally funded, comprehensive, no-deductible, no-copay Medicare for every man, woman, and child in America.
The federal government could pay for the whole thing by tapping a computer key, and it could do it without the need to supervise private insurance services.
The hugely profitable private healthcare insurers, who bribe Congress, would object.
And, of course, the rich who run America don’t want it, because it would narrow the income/wealth/power Gap between the rich and the rest of us. Keeping the poorer poor is how the rich stay rich. That is what the rich bribe Congress to do.
Legislation requiring insurers to more quickly approve requests for routine care passed unanimously in the House in 2022, but stalled in the Senate over cost concerns.
What do we do now? Medicare Advantage won’t pay.
Federal “cost concerns” are unnecessary.
Because the federal government is Monetarily Sovereign, cost never should be a primary consideration.
The Improving Seniors’ Timely Access to Care Act, which mandates insurers quickly approve requests for routine care and respond within 24 hours to any urgent request, was reintroduced this year in the House and passed out of the House Ways and Means Committee this summer as part of a larger health care package.
Still, lawmakers are peppering the Biden administration with demands for reforming the commonly used tool called prior authorization, the process in which health insurers require patients to get insurer approval ahead of time for certain treatments or medications.
Without prior authorization, Medicare Advantage would have no price “advantage,” and scant ability to compete with Medicare.
It “has turned into a process of basically just stopping people from getting care,” said Rep. Pramila Jayapal (D-Wash.), leader of the House Progressive Caucus.
Stopping people from getting care — i.e. stopping health insurers from paying big bills — is the point. Imagine a car insurer demanding that people get prior authorization before starting the car, and then denying any long or more risky drives.
Jayapal was one of more than three dozen House Democrats who told CMS this month of “a concerning rise in prior authorizations,” accused health insurers of prioritizing “profits over people” and asked for “a robust method of enforcement to rein in this behavior.”
Oh, really” A business that prioritizes profits? Who could have predicted that? There would be no need to “rein in this behavior” if the federal government funded health care.
Unlike traditional Medicare, Medicare Advantage plans can employ prior authorization and restrict beneficiaries to certain doctors within their network. Those are among the incentives private insurers have to participate in the program and enrollment has doubled during the last decade.
But Sen. James Lankford (R-Okla.) said some hospitals in his state won’t take Medicare Advantage plans any more. “We can’t do it because we can’t afford the constant chasing from all the denials,” he said.
AHIP, the trade group representing insurers, told POLITICO that prior authorization was among the tools that can curb wasteful spending.
Prior authorization has very little to do with wasteful spending and everything to do with cutting big costs. If a doctor, who knows a patient, authorizes a procedure, and some lowly insurance company employee, who never met the patient refuses to pay for the doctor-authorized procedure, how does that prevent “wastefulspending?
“These tools are important when coordinating care, reducing unnecessary and low-value care, and promoting affordability for patients and consumers,” said spokesperson David Allen in a statement.
Utter nonsense. It’s double-talk for “the less we pay, the more we make.”
CMS has a track record of responding to liberal concerns, which could translate into big changes for Medicare Advantage in the coming years. Earlier this month, it proposed a rule to improve the standards for behavioral health networks following complaints from Congress about woefully inaccurate mental health provider directories, which some lawmakers said amounted to fraud.
How are we going to pay this? I thought we were covered.
It also for the first time this year is evaluating Medicare Advantage television ads before they air, following prodding from lawmakers and numerous complaints from elderly consumers who felt duped by the ubiquitous ads.
Interesting that Medicare Advantage can provide “more benefits” at “lower prices,” and still afford all that television advertising, reap profits, and even pay taxes — and compete with Medicare. Do you believe in magic? Where does all the extra money come from? Service refusal.
CMS also proposed a rule earlier this month that plans be required to factor the impact of prior authorization denials on marginalized and underserved communities, part of a larger effort by the agency to close gaps in health equity. The rule, if finalized, would take effect in 2025.
You can be sure that the insurance companies will find a way around that one. Service denial is the bedrock of Medicare Advantage. Without service denial, the program could not exist.
Sen. Elizabeth Warren (D-Mass.), who wants the agency to go further, has proposed an amendment that would require CMS to collect and publish data from Medicare Advantage plans on their prior authorization practices to make public the number of prior authorization requests, denials and appeals by type of medical care.
She has support from Sen. Mike Crapo (R-Idaho), who said during a recent hearing that his support for Medicare Advantage plans “does not mean that I like the prior authorization process and that I do not see some problems here that need to be solved.”
Original Medicare does not require prior authorization. Congress could outlaw the whole prior authorization, service denial scam, but that would end Medicare Advantage and all those wonderful profits, along with all those wonderful political bribes.
Insurer advocacy group Better Medicare Alliance told POLITICO it supports legislation and regulations to create an electronic prior authorization process that could expedite prior authorization decisions that typically take up to a week or more.
No, expediting a failed process doesn’t make it a good process. The whole process says, “We know more than your doctor about your health needs” and/or “Your doctor is crooked, so we’ll have one of our flunkies make your healthcare decisions.”
“Our goal has always been to protect prior authorization’s essential function — coordinating safe, effective, high-value care— while also strengthening and streamlining this clinical tool to better serve beneficiaries,” Mary Beth Donahue, president and CEO of the group, said in a statement.
Pardon me if I laugh, but does anyone believe the purpose of prior authorization is to “coordinate safe, effective, high-value care, while strengthening blah, blah, blah”? The purpose of prior authorization is to save money via service denial. Period.
BY DAVID LIM AND ADAM CANCRYN | AUGUST 23, 2023 Creighton suspects insurers would be fine with implementing guardrails for prior authorization, as long as they can continue to use it.
“It is super important that in this case one doesn’t throw out the prior authorization with the bath water,” he said. “It is just finding that balance.”
No, that is exactly what should be done: Throw out prior authorization. It’s an invitation to cheating helpless, sick patients stuck with big bills or no service.
But many physicians complain that balance has tipped too far in favor of Medicare Advantage plans.
A survey released earlier this month by the physicians’ trade group Medical Group Management Association found 97 percent of medical group practices said an insurer delayed or denied medically necessary care.
Another 92 percent said they had hired staff specifically to process prior authorization requests. A December 2022 survey from the American Medical Association also found that 94 percent of physicians reported care delays due to prior authorization denials or processing.
“Even when you are doing the most cost-effective treatment, you are going through the [prior authorization] process,” said Vivek Kavadi, chief radiation oncology officer for U.S. Oncology, a network of more than 1,200 physicians.
Studies show that oncology faces the most prior approval requests.
“I’m sorry Mrs. Jones, but we can’t operate on your cancer until we get prior authorization. It could take weeks, while your cancer grows and metastasizes. Or the procedure could be denied in which case you’ll be on the hook for $50,000 which will bankrupt you and your family. Or maybe, you’ll just die. Which do you choose?”
Five oncologists told POLITICO that prior authorization requests are increasing as more patients migrate from traditional Medicare to Medicare Advantage. This surge of insurer prior approval demands has put a strain on their practices’ resources, they said.
The people who migrate tend to be the ones who least can afford to pay for denied procedures. As usual, the rich have found a way to cheat the middle and the poor.
Insurers may at times contract with radiation benefit managers, companies that manage claims processing and keep a cut of savings they generate.
This can encourage more services requiring prior authorization and create a “greater incentive to identify opportunities where denials can be pushed on to the provider,” said Constantine Mantz, chief policy officer for the oncology network GenesisCare.
If you pay people to deny services, they will deny services.
EviCore, a radiation benefit manager, said its work is meant to ensure patients receive care grounded in the latest clinical evidence as quickly as possible. “For requests that don’t meet evidence-based guidelines, the [physician] has the opportunity to discuss the case … which can help resolve any concerns prior to initiating a formal appeal,” the company said in a statement.
So, the goal is to prevent a doctor from prescribing an unnecessary procedure, and this will be cleared up when the doctor discusses the case with a “benefit manager”? Really?
BMA did not wish to comment and AHIP declined to respond to a list of questions on radiation benefit managers.
Medicare Advantage plans have been slow to update their coverage policies and at times lag Medicare in which treatments are covered, Mantz said. This can lead to situations where a Medicare Advantage plan denies care after a prior authorization request that would be covered under traditional Medicare.
Of course. What other outcome could there be? The whole purpose of prior approval is to deny payment.
BY ALICE MIRANDA OLLSTEIN AND LAUREN GARDNER | OCTOBER 05, 2023 05:00 AM HHS’ Office of the Inspector General in a 2022 report found 13 percent out of a sample of claims from Medicare Advantage plans in which care was denied under prior authorization for services that should have been approved.
You can be sure the 13 percent figure is low, but even if were accurate, would you go to a hospital knowing there was a 13 percent chance your legitimate procedure would not be covered? I wouldn’t.
If a request is denied, a doctor can file an appeal and eventually speak with another physician to plead their case.
This is exactly what you don’t want your doctor spending his valuable time doing: Pleading his case to another doctor who has not seen you and doesn’t even know you.
Recent studies have shown that most appeals to a denial get overturned. In 2021, Medicare Advantage plans fully or partially denied more than 2 million claims through prior authorization, but 82 percent of those were overturned after an appeal, according to an analysis from the think tank KFF.
A 2019 survey from ASTRO found 62 percent of oncologists, who appealed on behalf of their patients, got their prior authorization denial overturned.
If the vast majority of denials are overturned, something clearly is wrong with the denial process. It would be informative to know why denials are overturned. What are the circumstances that cause all those “bad” denials and their cancellation.
Apparently, those denials were unnecessary, and when the doctors caught the insurance companies with their hands in the cookie jar, the denials were reversed. The insurance companies seemingly tell their people, “Deny everything you can, but if a doctor objects, reverse the denial. Just make the process as tedious as possible.”
But doctors say getting through the appeals process can take weeks.
“It feels more like the business model is a way for insurance companies to potentially reduce costs by feeling that physicians won’t want to participate in this peer-to-peer process because it is a burden on time,” said Amar Rewari, chief of radiation oncology for the Maryland-based health system Luminis Health.Mei
The insurance companies increase profits by making the process difficult for patients and doctors. This is the opposite of what one would expect from a health service.
SUMMARY
No public purpose is served by transferring the cost of health care to the private sector, where profitability requirements can supersede healthcare needs.Though cutting prices is a selling strategy, it is a poor tradeoff for bad service.
Innocent consumers, lured in by lower prices and coverages not offered by Original Medicare, too often find themselves uninsured at just the times when they need help most, with bankruptcy-causing bills or not receiving medical care at all.
The federal government already had proved its capability of funding healthcare services with Original Medicare. a relatively no-hassle service.
Unnecessarily, Medicare saves money by not paying for everything. There are co-pays, deductibles, and some services not covered. But the federal government, being Monetarily Sovereign, does not need to save money. It has infinite dollars.
The federal government is financially capable of providing comprehensive, all-inclusive, no-copay, no-deductible Medicare to every man woman and child in America, without collecting a penny in taxes.
The purpose of government is to improve and protect the lives of the people. The U.S. government, having unlimited financial capability, and already having the experience funding medical care, should carry out its mandate.
I believe the people at AARP understand that our government, being Monetarily Sovereign, never can run short of its own sovereign currency, the U.S. dollar.
They must know that even if all federal tax collections — income taxes, payroll taxes, etc. — and every other form of federal government income totaled zero, the government could continue spending forever.
The sole purposes of federal taxes (unlike state, local taxes) are not to provide the government with spending money, but:
To control the economy by taxing what the government wishes to discourage and by giving tax breaks to what the government wishes to reward.
To assure demand for the U.S. dollar by requiring taxes to be paid in dollars
And the hidden reason: To help the very rich become richer by widening the Gap between the rich and the rest.
Stated simply, the U.S. federal government can pay for anything it wishes without taxing anyone.
AARP claims it “is the nation’s largest nonprofit, nonpartisan organization dedicated to empowering Americans 50 and older to choose how they live as they age. Advocating for people age 50-plus is at the heart of our mission.”
So why does the AARP repeatedly indicate the federal government can’t afford to pay for a comprehensive, no deductible Medicare benefit for every man, woman, and child in America?
Could their lucrative insurance business be the reason?
Here are excerpts from an article in the October, 2023 AARP Bulletin: (By Dena Bunis, who covers Medicare, health care, health policy and Congress. She also writes the Medicare Made Easy column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for The Orange County Register and as a health policy and workplace writer for Newsday.)
For decades, as Americans approached their 65th birthday, all they had to do to get Medicare, the nation’s government-sponsored health insurance for older adults, was sign up.
The program wasn’t all that complicated. You went to the doctor armed with your Medicare card. Your physician or hospital took care of you and billed Medicare. Then you —or the supplemental (Medigap) planyou bought — paid your out-of-pocket share. Easy.
Today’s Medicare isn’t your grandparents’ program. New enrollees have an immediate big decision to make: Should they enroll in original Medicare (also referred to as traditional Medicare) or sign up for the private insurance managed care alternative, Medicare Advantage (MA)?
But why? Why is a decision needed?
AARP doesn’t explain why there are two plans, and why people are forced to choose between them. AARP also doesn’t explain why everyone, young or old must pay for some form of healthcare insurance, or have an employer pay.
In short, AARP doesn’t discuss the true question: Why doesn’t the federal government simply pay for everyone’s healthcare?
AARP profits by providing in their words, “health security, financial stability and personal fulfillment. AARP also works for individuals in the marketplace by sparking new solutions and allowing carefully chosen, high-quality products and services to carry the AARP name.”
Clearly, Medicare for All would be a financial disaster for AARP.
The two options not only differ in how they operate but increasingly in what coverage and services they provide. Making the decision requires looking down two roads that more and more are heading in different directions.
Original Medicare’s biggest draw remains the freedom enrollees have to go to any doctor or hospital in the country that takes Medicare.
In most cases, you don’t need a referral to go to a specialist or get a covered procedure done. It’s a simple fee-for-service insurance structure that was once commonplace across America but has mostly vanished for those under 65.
InMedicare Advantage, plans can feel more familiar, as they closely resemble the managed care plans offered by many employers, often in the form of a health maintenance organization (HMO) or preferred provider organization (PPO).
An MA plan is the one-stop-shopping alternative that bundles hospital, doctor and prescription drug coverage.
Most offer extra benefits not in original Medicare. MA plans also cap how much beneficiaries must pay out of pocket each year, something original Medicare does not.
The sole purpose of government is to improve and protect the lives of the people. That said, there is no reason why a federally funded plan cannot do everything Medicare + Medicare Advantage + every company-funded plan does — and without charging the American people one cent.
That is one way our government should improve and protect our lives.
(And no, this isn’t “socialism,” which is government ownership and control. It’s merely government funding, which is what the government currently does millions of times a day.)
Another big difference: Original Medicare is managed entirely by the federal government (oversight by Congress, day-to-day operations by the Centers for Medicare & Medicaid Services (CMS), meaning it is not operated for a profit.
That’s not exactly correct. The payment is managed by the government, but the services come from the private sector. The doctors, hospitals, the technicians, etc. are in the private sector.
The exception is the VA health system, which is owned and operated by the federal government.
Advantage plans, by contrast, are operated by private and often for-profit organizations that get flat-rate payments from the government to provide health care to an enrollee.
The financial difference is more apparent than real. The federal government still pays, but with Medicare Advantage, private insurance companies and their profit requirements are inserted as (unnecessary) middlemen between the providers and the government.
MA’s promise of extra benefits and lower premiums has been effective. In 2008, only 22 percent of beneficiaries were in Advantage plans. Since then, enrollment in these managed care plans has more than doubled and continues to grow.
In 2023, more than half of Medicare’s 60 million beneficiaries who have both Medicare parts A and B are enrolled in an MA plan.
And that’s the irony of the entire system. The government pays for both medical plans, but they offer different benefits. Medicare could (and should) offer the same or even better benefits MA offers. But it doesn’t.
Why? Because Americans have been brainwashed into believing that Medicare “can’t afford” to provide such benefits, and that in some mysterious way, Medicare can run out of money.
Medicare now finds itself at a crossroads. Based on current patterns, it won’t be long before enrollment in MA plans substantially overtakes enrollment in original Medicare.
Does the original need to be changed to remain competitive with MA? More fundamentally, will original Medicare as envisioned by President Lyndon Johnson and Congress in 1965 cease to exist in the years to come?
“I genuinely do believe that the future of Medicare lies in Medicare Advantage,” says James E. Mathews, executive director of the Medicare Payment Advisory Commission (MedPAC), established by Congress to analyze the program and provide advice. Mathews expects there will be a “natural migration” to MA, but he’s not sure whether that means original Medicare will disappear.
“It remains to be seen whether there is going to be some subset of the Medicare population for whom Medicare Advantage simply will not work.”
Medicare and Medicare Advantage will work if the benefits of both plans are blended into a Medicare for All plan.
Preserving and strengthening Medicare is one of AARP’s key policy concerns. That includes maintaining original Medicare.
“We strongly believe that traditional Medicare should be protected and strengthened and that there has to be a level playing field between traditional Medicare and Medicare Advantage,” says Megan O’Reilly, AARP vice president for health and family issues.
CMS Administrator Chiquita Brooks-LaSure oversees all Medicare operations. She says her priority is to strengthen both options. “I believe it’s critical that people have a choice between traditional original Medicare and Medicare Advantage,” Brooks-LaSure said in aninterview with AARP.
It’s like claiming that people should have a choice between an all-meat diet and an all-vegetable diet. Most people would prefer to blend the two into one complete plan.
Even experts who are most bullish on Medicare Advantage say they don’t expect original Medicare to go away. The main reason is choice.
Chiquita Brooks-LaSure, Administrator of the Centers for Medicare & Medicaid Services. Does she really not know that the federal government can fund one plan that offers every benefit?
The case for keeping original Medicare
Under original Medicare, you can go to any doctor, lab or hospital in the U.S. that participates in the program (about 90 percent of medical professionals do).
In MA plans, enrollees mostly must go to providers within the plan’s network, and these networks are highly regionalized. Going out of network means facing a much higher copay for each visit. In some cases, the care may not be covered at all.
“There are always going to be a lot of people who are going to say, ‘Look, I want to go to a doctor I want, and I don’t want to be limited,’ ” says Tom Scully, who was CMS administrator from 2001 to 2003 and is a supporter of Medicare Advantage. As a result, “I think original Medicare will never go away.”
“I believe it’s critical that people have a choice between traditional original Medicare and Medicare Advantage.”
— Chiquita Brooks-LaSure, CMS Administrator
Until they enroll, many Americans don’t realize how costly and complicated Medicare can be. That is especially true if you choose original Medicare.
Most original enrollees must make three regular insurance payments: one for basic Part B coverage, one for a Part D prescription plan, and one more for a Medigap policy to cover some or all of the expenses that Medicare doesn’t.
And there are other expenses on top of the premiums; for example, original Medicare Part B has an annual deductible ($226 in 2023); there’s also a deductible for every hospital visit, which in 2023 is $1,600. Those charges take a heavy financial toll.
All those premiums, deductibles an lack of coverage are unnecessary. The federal government could, and should fund one program encompassing all benefits. Why force people to forego some benefits?
By contrast, an Advantage plan enrollee usually has just one recurring payment: It includes the government-mandated Part B coverage cost and, in some cases, a small additional premium, which varies by what plan you choose and where you live.
You pay various copays and deductibles for your services and doctor visits, but the rest is fully covered by the plan, and you know going in what the copay is for the different providers. Costs under MA can also add up, though, especially if you need hospital care; most plans have a per-day hospital charge.
An important dividing line when choosing a Medicare path is whether a beneficiary can afford to pay the added monthly costs of a Medigap policy to supplement original Medicare coverage, as well as for a separate Part D prescription plan.
The federal government could and should pay for the above coverages.
The difference in “choice” between original Medicare and an MA plan isn’t simply which doctor you can see.
In an MA plan, the care you need is likely to be more scrutinized than in an original plan.
Insurers that run MA plans often require what’s calledprior authorizationbefore paying for your tests and procedures; that means a doctor must get approval for recommended care from internal reviewers before the treatment will be covered.
Why does MA require prior authorization, while Medicare does not? MA is ruled by the profit motive, while Medicare is ruled by the political motive.
MA can refuse unprofitable procedures. Medicare can afford to fund procedures that have political support, regardless of cost.
Some MA plans also require referrals to specialists, meaning if you wish to see, say, a cardiologist, you’ll need your primary care doctor’s blessing.
People in original Medicare usually don’t need referrals to see specialists, and as long as Medicare covers a test or treatment a doctor orders, except in a few situations, Medicare will pay for it.
If you develop a health condition that requires specialized surgery or highly advanced therapies to treat; in an MA plan, you likely won’t be coveredif you seek care from a doctor or medical center that specializes in your issue but is out of the network.
The above is the result of the profitmotive taking precedence.
On the other hand, most MA plans have benefits that original Medicare does not. The out-of-pocket cap is a big one; in 2023, MA enrollees know they won’t have to pay more than $8,300 in total annual health costs, although many plans have lower out-of-pocket limits than that.
Once again, there is no out-of-pocket cap in original Medicare.
Why are people subject to any out-of-pocket costs, when the federal government has infinite money to pay for medical care? No reason outside of the false claims that the federal government can run short of money.
Most MA plans cover basic dental, vision and hearing services.
Why does Medicare not cover dental, vision and hearing? Again, no good reason. Just the Big Lie about federal finances.
Some provide what are called Medicare flex cards that beneficiaries can use to pay for over-the-counter medications and other drugstore items, as well as healthy food.
In recent years,Congress began allowing MA plansto pay for making improvements to beneficiaries’ homes, such as wheelchair ramps and shower grips in bathrooms. Some plans pay for gym membershipsor transportation to doctors’ offices.
These are benefits the federal government could and should support; they increase the health of the people.
David Lipschutz, associate director of the Center for Medicare Advocacy, supports the ability of Medicare to help pay for nonmedical services that can help keep an older American healthy.
But he says it’s not fair that enrollees must be in a Medicare Advantage plan to take advantage of those extras. “One should not be forced to enroll in a private plan to access such services,” Lipschutz says.
No, it’s not fair that people should be forced to pay for any medical benefits when the federal government has the infinite ability to pay.
Imagine you have a few trillion dollars to your name, and your daughter needs expensive surgery. Would you pay for her the life-saving health care? The government has many trillions. It should follow its mandate to protect our lives.
Advocates and patients agree that MA plans seem fine as long as you’re healthy. But too often, beneficiaries with serious illnesses find it more difficult to get the care they say they need.
A 2022 report from the Government Accountability Office (GAO), a congressional watchdog, found that “Medicare Advantage beneficiaries in the last year of life left the program to join traditional Medicare at twice the rate of other beneficiaries. This could indicate potential problems with their care.”
The profit motive incentivizes private insurance companies to be excellent premium collectors but reluctant health care providers.
“Denials may be more frequent in Medicare Advantage plans than in traditional Medicare for people who have serious health problems,” says Tricia Neuman, senior vice president and head of the Medicare program at KFF, formerly the Kaiser Family Foundation.
That could be a real concern. When people age into Medicare, they tend to be healthier than they will be as they grow older and have more health problems, and that may not be top of mind.”
A federally funded, comprehensive, no-deductible Medicare for All would not have that problem.
Original Medicare may have another disadvantage: television. Throughout the year, but most prominently during Medicare open enrollment season each fall, ads for Medicare Advantage plans blanket broadcast and cable television stations.
From NFL Hall of Famer Joe Namath to “Captain Kirk” William Shatner to Jimmie Walker of “dy-no-mite” fame, celebrities urge older adults to call an 800 number and get lots of extras and benefits from Medicare Advantage plans.
Individual insurers also run ads, and some Medigap plans take to the airwaves. There are no such commercials for original Medicare.
Plenty of money for advertising; not enough for benefits.
“There’s nothing that helps lay out the trade-offs” between original and Medicare Advantage, says Gretchen Jacobson, vice president of Medicare at the nonpartisan Commonwealth Fund. “So if you just pay attention to the Medicare Advantage marketing, you may not really understand what the advantages and disadvantages are.”
“When we did focus groups with brokers, many said they are paid more to put people into Medicare Advantage plans, sometimes much more”
— Gretchen Jacobson, vice president of Medicare at the nonpartisan Commonwealth Fund.
And here is where the profit motive really comes into play:
“When we did focus groups with brokers, many said they are paid more to put people into Medicare Advantage plans, sometimes much more,” Jacobson said. But “if they were going into Medicare tomorrow, most of them said they would choose to be in traditional Medicare.”
These brokers do not get any commission for helping someone enroll in original Medicare. Likewise, they said most Part D prescription plans don’t offer commissions; for those that do, the rate is low.
As for Medigap policies, an agent might get some money for signing people up, but agents say it’s not as much as what they get for a Medicare Advantage enrollment.
The combination of insurance company advertising and insurance broker commissions puts people into Medicare Advantage, when that may not be the wisest choice, and certainly not the least expensive choice (which would be federally funded Medicare for All).
Universal health care for everyone in the United States promises only government inefficiency and health care that ignores the realities of the country and the free market.
“The VA system is not only costly with inconsistent medical care results, it’s an American example of a single-payer, government-run system.
We should run from the attempts in our state to decrease competition in the health care system and increase government dependency, leaving our health care at the mercy of a monopolistic system that does not need to be timely or responsive to patients.
The above supposedly is a negative about Medicare for All, except it isn’t. It is a negative about something no one proposes: VA-style federally owned and operated hospitals with providers being employees of the government.
It’s a fake, perhaps intentionally misleading, negative that no one wants. Medicare for All would be federally funded, not owned and operated. It would be an expanded version of Medicare without the FICA tax.
2. The challenges of universal health care implementation are vastly different in the U.S. than in other countries, making the current patchwork of health care options the best fit for the country.
Though the majority of post-industrial Westernized nations employ a universal healthcare model, few—if any—of these nations are as geographically large, populous, or ethnically/racially diverse as the U.S.
Different regions in the U.S. are defined by distinct cultural identities, citizens have unique religious and political values, and the populace spans the socio–economic spectrum. Moreover, heterogenous climates and population densities confer different health needs and challenges across the U.S.
Thus, critics of universal healthcare in the U.S. argue that implementation would not be as feasible—organizationally or financially—as other developed nations.”
Yes, blah, blah, blah, America is too big, too diverse, too climate-challenged, all great arguments except for one small detail. Medicare already has solved those fake problems. It funds health care all over our big country, and is quite popular, thank you.
3. Government controlis a large driver of America’s health care problems.
Bureaucrats can’t revolutionize health care – only entrepreneurs can. By empowering health care entrepreneurs, we can create an American health care system that is more affordable, accessible, and productive for all,” explains Wayne Winegarden, Senior Fellow in Business and Economics, and Director of the Center for Medical Economics and Innovation at Pacific Research Institute.
Someone please tell Mr. Winegarden that bureaucrats wouldn’t be in charge of revolutionizing anything. They merely would write the checks, just as they do now for Medicare.
4. Universal health care would increase wait times for basic care and make Americans’ health worse.
If coverage was nearly universal, cost sharing was very limited, and the payment rates were reduced compared with current law, the demand for medical care would probably exceed the supply of care–with increased wait times for appointments or elective surgeries, greater wait times at doctors’ offices and other facilities, or the need to travel greater distances to receive medical care. Some demand for care might be unmet.
Rephrasing the objection: “If everyone could get free healthcare, there wouldn’t be enough doctors, nurses, and hospitals to treat us rich folks. It’s better that some poorer people do without, so we don’t have to.”
The same objection could have been made to original Medicare.
However, if the federal government, which can afford anything, pays enough to those doctors, nurses, and hospitals, more people will enter the profession and more hospitals will be built.
It is a fake objection, the purpose of which is to widen the income/wealth/power Gap between the rich and the rest.
5. Universal health care would raise costs for the federal government and, in turn, taxpayers.
Medicare-for-all, a recent universal health care proposal championed by Senator Bernie Sanders (I-VT), would cost an estimated $30 to $40 trillion over ten years.
The cost would be the largest single increase to the federal budget ever.
Here, we have come to the Big Lie in economics, the lie that federal taxes fund federal spending. It is a lie promulgated by the very rich to discourage those who aren’t rich from asking for benefits.
The rich use the confusion between monetarily non-sovereign local and state governments vs, Monetarily Sovereign federal government.
State and local governments cannot create dollars at will, so they rely on tax income to fund their spending. The federal government can create dollars at will, so it does not use tax dollars. In fact, the federal government destroys all your tax dollars upon receipt.
You pay your taxes with dollars from your checking account which are part of the M2 money supply measure. Once your tax dollars reach the U.S. Treasury, they no longer are part of any money supply measure. They effectively are destroyed.
The Federal Reserve creates dollars at willby purchasing securities from a bank (or securities dealer) and paying for the securities by adding a credit to the bank’s reserve(or to the dealer’s account) for the amount purchased. In short, the Fed creates dollars from thin air, whenever it wishes.
Former Fed Chair Alan Greenspan: “A government cannot become insolvent with respect to obligations in its own currency. There is nothing to prevent the federal government from creating as much money as it wants and paying it to somebody. The United States can pay any debt it has because we can always print the money to do that.”
Former Fed Chair Ben Bernanke: “The U.S. government has a technology, called a printing press (or, today, its electronic equivalent), that allows it to produce as many U.S. dollars as it wishes at essentially no cost.”
Thus, the federal government can, at the touch of a computer key, fund a free, comprehensive, no deductible, Medicare program to protect every man, woman, and child in America.
SUMMARY
There is not a single financial reason why the government doesn’t improve and protect the lives of the people’s health, one of the jobs for which it was formed.
Every argument against free Medicare for all is based on ignorance and/or a lie. In creating Medicare, we already have done the hard part. It is only left to us to expand Medicare while ending all medical taxes and fees, and voila, we have Medicare for All.
Sadly, the rich and the insurance companies prevent the government from doing its job.
You don’t have free, comprehensive, no-deductible health care. Don’t blame “insolvency,” lack of money, inflation, lack of caregivers, or any other factor.
Blame the rich and the private insurance providers like AARP et al, for promulgating theBig Lie.
#Monetary Sovereignty - Mitchell 